Drivers for human papillomavirus vaccination in Valencia (Spain)

Gac
Sani .
2018;32(5):454–458
O iginal
a icle
D i e s
o
human
papilloma i us
accina ion
in
Valencia
(Spain)
Ped o
Na a o-Illanaa,
Es he
Na a o-Illanaa,
Ra ael
Vila-Candela,b,∗,
Ja ie
Díez-Domingoa,c
aFacul y
o
Nu sing,
Uni e sidad
Ca ólica
de
Valencia
San
Vicen e
Má i ,
Valencia,
Spain
bDepa men
o
Obs e ics
and
Gynaecologis ,
Hospi al
La
Ribe a,
Alzi a
(Valencia),
Spain
cFISABIO-Public
Heal h,
Valencia,
Spain
a
i
c
l
e
i
n
o
A icle
his o y:
Recei ed
30
Janua y
2017
Accep ed
15
May
2017
A ailable
online
13
July
2017
Keywo ds:
Human
papilloma i us
Vaccines
D i e s
A i udes
Nu se
a
b
s
a
c
Objec i e:
To
desc ibe
he
d i e s
associa ed
wi h
HPV
accina ion
in
adolescen
gi ls
and
hei
pa en ’s
opinion
on
he
accine.
Me hods:
We
conduc ed
an
obse a ional
and
c oss-sec ional
s udy
on
adolescen
gi ls
and
hei
pa -
en s
in
Valencia
(Spain),
be ween
Sep embe
2011
and
June
2012.
A
consul a ion
was
made
a
a
andom
sample
o
schools
o
he
14-yea -old
gi ls
ha
should
ha e
ecei ed
he
accine
in
he
ee
accina ion
p og amme.
We
an
a
pe sonal
su ey
on
knowledge
and
a i udes
ega ding
HPV
in ec ion
and
he
ac-
cine.
A
bina y
logis ic
eg ession
model
was
pe o med
o
de e mine
which
ac o s
we e
mos
associa ed
wi h
accina ion.
Resul s:
The
su ey
was
un
on
a
binomial
o
1,278
gi ls/mo he s
in
31
schools,
o
which
833
gi ls
and
hei
mo he s
esponded
(64.0%).
The
ac o s
associa ed
wi h
accina ion
we e:
coun y
o
o igin
o
he
amilies
(adjus ed
OR
[aOR]:
0.49;
95%
confidence
in e al
[95%CI]:
0.24-0.98),
ci il
s a us
o
he
pa en s
(aOR:
0.33;
95%CI:
0.13-0.81),
knowledge/belie s
abou
he
accine
when
he
sou ce
o
in o ma ion
was
he
nu se
(aOR:
1.83;
95%CI:
1.01-3.35),
in o ma ion
sou ce
abou
he
accine
(aOR:
2.32;
95%CI:
1.37-
3.92),
p e en i e
heal h
cen e
isi s
(aOR:
2.1;
95%CI:
1.10-4.07),
and
nu se
ad ice
(aOR:
6.6;
95%CI:
3.19-13.56).
Conclusions:
The
main
ac o
associa ed
wi h
HPV
accina ion
was
he
ad ice
o
heal h
p o essionals.
The e o e,
he
mos
e ec i e
in e en ions
o
imp o e
accina ion
co e age
should
ocus
on
heal h
p o essionals.
©
2017
SESPAS.
Published
by
Else ie
Espa˜
na,
S.L.U.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
Fac o es
asociados
a
la
acunación
con a
el
i us
del
papiloma
humano
en
Valencia
(Espa˜
na)
Palab as
cla e:
Vi us
del
papiloma
humano
Vacuna
Fac o es
asociados
Ac i ud
En e me ía
e
s
u
m
e
n
Obje i o:
Desc ibi
qué
ac o es
se
asocian
a
la
acunación
con a
el
i us
del
papiloma
humano
(VPH)
en
adolescen es
y
la
opinión
de
sus
pad es/mad es
sob e
dicha
acuna.
Mé odos:
Se
lle ó
a
cabo
un
es udio
obse acional
y
ans e sal
en
chicas
adolescen es
y
sus
p ogeni o es
en
Valencia
(Espa˜
na),
en e
sep iemb e
de
2011
y
junio
de
2012.
Se
ealiza on
consul as
a
las
ni˜
nas
de
14
a˜
nos
que
end ían
que
habe
sido
acunadas
den o
del
p og ama
de
acunación
g a ui a,
en
una
mues a
alea o ia
de
colegios.
Se
p egun ó
sob e
conocimien os
y
ac i ud
espec o
a
la
in ección
po
el
VPH
y
la
acuna,
median e
en e is a
pe sonal.
Se
lle ó
a
cabo
un
modelo
de
eg esión
logís ica
bina ia
pa a
de e mina
qué
ac o es
es aban
más
asociados
con
la
acunación.
Resul ados:
Se
en e is ó
a
1278
binomios
chica/mad e,
con
una
asa
de
espues a
del
64,0%
(833).
Los
ac o es
asociados
a
la
acunación
ue on
el
país
de
o igen
de
las
amilias
(odds
a io
ajus ada
[ORa]:
0,49;
in e alo
de
confianza
del
95%
[IC95%]:
0,24-0,98),
el
es ado
ci il
de
los
p ogeni o es
(ORa:
0,33;
IC95%:
0,13-0,81),
los
conocimien os/c eencias
sob e
la
acuna
cuando
la
p incipal
uen e
de
in o mación
ue
la
en e me a
(ORa:
1,83;
IC95%:
1,01-3,35),
la
uen e
de
in o mación
sob e
la
acuna
(ORa:
2,32;
IC95%:
1,37-3,92),
las
isi as
p e en i as
al
cen o
de
salud
(ORa:
2,12;
IC95%:
1,10-4,07)
y
el
consejo
de
la
en e me a
(ORa:
6,57;
IC95%:
3,19-13,56).
Conclusiones:
El
p incipal
ac o
asociado
a
la
acuna
del
VPH
ue
el
consejo
del
pe sonal
sani a io,
po
lo
que
las
in e enciones
pa a
aumen a
la
cobe u a
acunal
deben
cen a se
en
es e
colec i o.
©
2017
SESPAS.
Publicado
po
Else ie
Espa˜
na,
S.L.U.
Es e
es
un
a ´
ıculo
Open
Access
bajo
la
licencia
CC
BY-NC-ND
(h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
∗Co esponding
au ho .
E-mail
add ess:
[email p o ec ed]
(R.
Vila-Candel).
In oduc ion
Human
papilloma i us
(HPV)
is
a
necessa y
cause
o
ce i-
cal
dysplasia
and
cance .
Geni al
wa s
a e
one
o
he
mos
h ps://doi.o g/10.1016/j.gace a.2017.05.008
0213-9111/©
2017
SESPAS.
Published
by
Else ie
Espa˜
na,
S.L.U.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-
nd/4.0/).
P.
Na a o-Illana
e
al.
/
Gac
Sani .
2018;32(5):454–458
455
p e alen
sexually
ansmi ed
diseases
in
Eu ope.
HPV
accine
co e age
is
hus
an
impo an
public
heal h
conce n
and
unde -
s anding
he
easons
o
accep ing
o
ejec ing
accina ion
is
essen ial
o
inc easing
compliance.1
The
easons
o
dec eased
accina ion
co e age
seemed
o
be
di e en
acco ding
o
egion
and
ci cums ances.2The e
we e
ac-
o s
such
as
he
nega i e
impac
o
mass
media,
misin o ma ion
om
an i- accina ion
mo emen s,
as
well
as
he
ini ial
“agg essi e”
campaigns
ca ied
ou
by
comme cial
companies.3–5 In
Spain,
hese
campaigns
s a ed
a
polemical
deba e
e en
be o e
he
accina ion
p og am
was
launched,
possibly
c ea ing
unce ain y
ega ding
he
indica ions
o
HPV
accina ion
among
some
heal hca e
p o es-
sionals.
Vaccina ion
co e age
in
he
fi s
campaign,
in
a
coho
o
gi ls
bo n
in
1994
accina ed
wi h
h ee
doses,
was
75.2%
o
he
o al
a ge
popula ion.
Howe e ,
in
he
ollowing
campaign
(1995
coho ),
i
dec eased
o
62.5%.
And
al hough
i
inc eased
again
sligh ly
o
67.6%
in
he
1996
coho ,
he
o e all
a e
did
no
imp o e
in
he
egion.6Economic
s udies
ca ied
ou
be o e
and
a e
he
accina ion
p og am
s a ed
ha
accina ion
co e age
o
70%,
o
highe ,
was
necessa y
o
p edic
cos -e ec i eness
o
an
in e en ion.2–5 Ne e heless,
hese
a es
we e
ela i ely
low
com-
pa ed
o
o he s
ob ained
in
England,
Sco land
o
Wales
(84.0%),
whe e
unding
and
implemen a ion
condi ions
we e
simila .7
P io
o
he
accina ion
p og am,
li e a u e
sugges ed
ha
e h-
nici y,
socio-demog aphic
and
psychosocial
ac o s
could
play
a
decisi e
ole
in
accina ion.8Resea ch
a e
he
accina ion
p o-
g ams
we e
launched6,8–14 confi med
ha
age,
pe cei ed
access
o
accina ion,
cul u al
no ms,
eligion,
knowledge
abou
he
se e i y
o
he
disease
and
isk
pe cep ion,
di ec ly
influenced
he
accep-
ance
o
he
accine.1,15 These
ac o s,
oge he
wi h
he
usual
accep ance
di ficul ies
ha
any
accine
may
ha e,
a e
a
challenge
o
achie e
be e
accina ion
co e age
a es.
This
s udy
was
designed
o
de e mine
he
d i e s
associa ed
wi h
HPV
accina ion
in
he
egion
o
Valencia
(Spain),
and
o
asce -
ain
whe he
he e
was
a
majo
de e mining
ac o
in
o de
o
ca y
ou
mo e
e ec i e
in e en ions
o
imp o e
accina ion
a es.
Subjec s,
ma e ial
and
me hods
Design
We
conduc ed
an
obse a ional,
and
c oss-sec ional
s udy
in
adolescen
gi ls
and
hei
pa en s
o
Valencia
(Spain)
be ween
Sep embe
2011
and
June
2012.
Sample
size
and
popula ion
A
andomized
and
s a ified
selec ion
o
schools
in
he
egion
o
Valencia
was
made,
acco ding
o
unding
(public,
p i a e
o
cha e
school)
and
geog aphic
loca ion
( u al,
semi u al
o
u ban).
This
coho
was
in
he
pos - accina ion
school
yea
and
should
ha e
ecei ed
he
accine
du ing
he
p e ious
yea .
We
included
hei
mo he s
(o he wise,
a he s
o
legal
gua dians)
since,
in
mos
cases,
hey
had
he
las
wo d
in
he
decision
o
accina e.
We
es ima ed
he
p e alence
o
70%
popula ion
adolescen
gi ls
accina ed.
We
assumed
a
popula ion
o
9,506,
wi h
a
Type
I
e o
(alpha
isk)
o
0.05,
an
accu acy
o
5%
and
a
d opou
a e
o
50%.
We
he e o e
calcula ed
a
sample
size
o
1,230
gi ls
and
espec i e
mo he s
o
ou
s udy.
Sample
size
was
unde aken
using
Epida
3.1.
Measu ing
ins umen s
and
s udy
a iables
An
en elope
wi h
a
ques ionnai e,
an
in o ma ion
shee
and
a
pa en al
consen
o m
was
gi en
o
each
gi l,
which
was
la e
e u ned
o
he
schools.
A e
checking
he
consen
o m,
we
in e -
iewed
he
gi ls
a
he
school
o
gua an ee
he
co ec
de elopmen
and
unde s anding
o
each
pa
o
he
ques ionnai e.
Be o e
da a
collec ion,
he
esea ch
eam
had
ca ied
ou
a
pilo
s udy
in
he
school
o
a
low-income
a ea
o
assess
comp ehension
di ficul ies
o
he
ques ionnai e,
as
well
as
he
co ec
da a
collec ion
p ocedu e.
All
amilies
ha
exp essed
hei
e use
o
pa icipa e
we e
excluded
o
he
s udy.
The
a iables
collec ed
comp ise:
•Socio-demog aphic
cha ac e is ics
included
we e
coun y
o
o i-
gin,
i
he
gi ls
li ed
wi h
hei
pa en s,
pa en s’
occupa ion,
and
eligion,
i
any.
•Heal h
s a us
and
use
o
heal h
esou ces
included
we e
abou
how
many
imes
hey
saw
hei
p ima y
ca e
physician
o
nu se
e e y
yea ,
as
well
as
i
hey
su e ed
om
any
diseases
o
we e
unde going
any
es s
(gynaecology
ela ed
o
in
gene al).
We
also
included
hei ,
as
well
as
hei
iends’,
a i udes
owa ds
accines
in
gene al,
and
he
ad ice
hey
ecei ed
om
hei
communi y
nu se
o
doc o
abou
accina ion.
•Rega ding
d ug
use
and
isk
pe cep ion
included
we e
abou
consump ion
o
alcohol,
obacco,
cannabis,
3,4-
me hylenedioxyme hamphe amine
(MDMA)
o
cocaine,
as
well
as
he
equency
o
use.
They
we e
also
asked
abou
how
conce ned
hey
we e
ega ding
issues
like
a fic
acciden s,
domes ic
o
wo k- ela ed
acciden s,
cance ,
dep ession,
sel -
es eem
p oblems,
sexual
ansmi ed
diseases,
o
new
epidemics,
among
o he s.
•Conce ning
hei
knowledge
abou
HPV
and
i s
accine,
we
inqui ed
i
hey
knew
whe e
he
HPV
in ec ion
p oduces
cance ,
as
well
as
how
i
was
ansmi ed,
ways
o
a oid
i
and
i
hey
knew
abou
any
ela i es
who
had
su e ed
om
ce ical
cance
o
i
hey
had
been
accina ed.
We
also
asked
abou
hei
isk
pe -
cep ion
and
how
hey
we e
in o med
abou
HPV
and
i s
accine,
and
whe he
hey
had
discussed
hei
doub s
wi h
hei
iends.
•Finally,
hey
we e
asked
whe he
hey
ecei ed
he
accine
(o ,
when
asking
he
mo he s,
whe he
hei
daugh e s
did),
whose
decision
i
was,
and
hei
easons
o
no
ecei ing
i
(i
non-
accina ed).
We
conside ed
hose
cases
alid
whe e
mo he s
and
daugh e s
eplied
and
had
consen
o ms
signed.
To
a oid
esponse
bias
and
de e mine
he
a iable
‘ accina-
ion
s a us’
wi h
eliabili y,
we
checked
he
mo he
and
daugh e ’s
answe s
agains
he
Nominal
Vaccine
Regis e
(NVR)
o
he
Pub-
lic
Heal h
Depa men ,
whe e
all
he
doses
adminis e ed
in
he
Regional
Heal h
Sys em
a e
egis e ed
(da e,
ba ch,
injec ion
si e,
name
o
heal hca e
p o essional
and
p ima y
heal h
cen e).
We
ound
no
disc epancy
in
he
‘Vaccina ion
S a us’.
We
conside ed
a
‘ accina ion
s a us’
o
be
posi i e
when
h ee
doses
we e
adminis e ed
and
egis e ed
in
he
NVR,
e en
i
mo h-
e s
and
daugh e s’
answe s
did
no
always
coincide.
In
con as ,
a
‘ accina ion
s a us’
was
nega i e
when
he
NVR
and
he
mo he s,
o
when
he
NVR
and
he
gi ls,
bo h
s a ed
ha
he
h ee
doses
o
he
accine
had
no
been
adminis e ed;
o
when
he
mo he s,
daugh e s
and
he
NVR
coincided
in
no
ha ing
he
h ee
doses.
An
unce ain
‘ accina ion
s a us’
was
ha
which
did
no
espond
o
any
o
he
abo e
and
hose
cases
we e
excluded
om
he
mul i-
a ia e
s udy.
S a is ical
analysis
Desc ip i e
s a is ics
da a
a e
p esen ed
as
means
and
s anda d
de ia ion
o
con inuous
a iables.
The
mul i a ia e
analysis,
fi s
analysing
each
a iable
wi h
he
accina ion
s a us
indi idually,
and
la e
using
a
bina y
logis ic
eg ession
o
find
he
associa ion
o
456
P.
Na a o-Illana
e
al.
/
Gac
Sani .
2018;32(5):454–458
each
a iable
wi h
he
accina ion
s a us.
Fo
he
selec ion
o
a i-
ables
o
he
p edic i e
model
we
used
significance,
sui abili y
and
oppo uni y
c i e ia
o
each
o
hem,
ollowing
a
logis ic
eg ession,
adjus ing
he
baseline
pa ame e s
and
wi hou
o cing
he
o de
o
he
selec ed
a iables.
Confidence
in e als
(CI)
we e
calcula ed
o
a
confidence
le el
o
95%,
and
p
<0.05
was
conside ed
s a is ically
significan .
S a is ical
analysis
was
unde aken
using
SPSS
( e sion
22;
SPSS,
Inc.
an
IBM
Company,
Chicago,
Illinois,
USA).
E hics
The
s udy
was
conduc ed
acco ding
o
he
p inciples
included
in
he
Helsinki
Decla a ion.
The
s udy
was
app o ed
by
he
Commi ee
on
Resea ch
-
E hics
Commi ee
o
he
Conselle ia
d’Educació
(Gen-
e ali a
Valenciana)
in
May
2011.
All
pa icipan s
we e
p o ided
ull
in o ma ion
o
conside
on
he
na u e
o
he
s udy,
olun a y
pa icipa ion,
and
confiden iali y.
Resul s
A
ques ionnai e
was
dis ibu ed
among
1,278
gi ls
and
hei
mo he s,
and
we
ob ained
833
adequa e
answe s
(64.5%;
95%CI:
61.9-67.1).
We
chose
a
sample
o
37
schools
bu
only
31
pa ici-
pa ed
(83.8%;
95%CI:
69.9-97.7),
ei he
because
hey
we e
no
gi en
au ho iza ion
by
he
pa en
school
go e ning
body
(n
=
4)
o
due
o
school
p og am
issues
(n
=
2).
F om
he
desc ip i e
analysis
o
he
gi ls’
socio-demog aphic
and
amily
p ofile
(Table
1),
we
ound
ha
86.1%
(95%CI:
83.7-84.8)
o
he
gi ls
we e
bo n
in
Spain,
79%
(95%CI:
76.2-81.8)
li ed
wi h
bo h
pa en s
and
85.5%
(95%CI:
83.2-88.0)
had
siblings.
Rega ding
eligion,
76.5%
mo he s
and
66.4%
daugh e s
we e
belie e s,
while
46.5%
and
30%,
espec i ely,
we e
p ac icing
indi iduals.
Rega ding
he
mul i a ia e
analysis
(Table
2),
om
833
cases,
73
(8.7%;
95%CI:
6.8-10.6)
we e
excluded
due
o
unce ain
accina ion
s a us.
A
o al
o
566
cases
(74.5%;
95%CI:
71.4-77.6)
we e
posi-
i e
accina ions
and
194
(25.5%;
95%CI:
22.4-28.6)
we e
nega i e
accina ions.
Six y-fi e
a iables
we e
selec ed
om
a
o al
o
155
o
be
included
in
he
logis ic
eg ession
model
(40
a iables
om
he
gi ls’
ques ionnai e
and
25
om
he
mo he s’).
The
final
logis ic
eg ession
model
included
84.5%
o
he
cases,
wi h
0.4
Cox
&
Snell
and,
0.6
Nagelke ke
coe ficien s.
The
success
a e
in
he
model
p e-
dic ion
in
accina ed
cases
was
92.1%
and
74.6%
in
non- accina ed
cases
(global
87.9%).
A e
con olling
o
he
co a ia es
included,
he
mul i a ia e
model
showed
ha
he
main
ac o s
associa ed
wi h
he
HPV
ac-
cina ion
we e
he
o igin
o
he
amilies
(adjus ed
odds
a io
[aOR]:
0.49;
p
=
0.04),
he
ci il
s a us
o
he
pa en s
(aOR:
0.33;
p
=
0.01),
knowledge/belie s
abou
he
accine
when
he
sou ce
o
in o ma-
ion
was
he
nu se
(aOR:
1.83;
p
=
0.048),
he
in o ma ion
sou ce
abou
he
accine
(aOR:
2.32;
p
=
0.002),
p e en i e
heal hca e
cen-
e
isi s
(aOR:
2.1;
p
=
0.02)
and
nu se
ad ice
(aOR:
6.6;
p
<0.001).
Discussion
This
was
one
o
he
mos
comp ehensi e
andomized
s udy
ca -
ied
ou
in
Spain.
I
had
a
la ge
sample
size
and
a
da a
collec ion
pe iod
o
eigh een
consecu i e
mon hs.
I
ocused
on
he
d i e s
associa ed
wi h
HPV
accina ion
in
o de
o
ca y
ou
mo e
e ec i e
in e en ions
o
imp o e
accina ion
a es.
We
obse ed
ha
74.5%
o
gi ls
we e
accina ed,
wi h
a
acci-
na ion
a e
sligh ly
highe
han
ha
published
by
he
Public
Heal h
Depa men
ha
yea
(66.5%),
p obably
because
he
p ofile
o
he
analysed
cases
which
did
no
answe
he
ques ionnai e
o
he
p o-
file
o
he
excluded
cases,
esponded
o
a
sligh ly
less
accina ed
Table
1
Socioeconomic
s a us:
sociocul u al
and
amily
a iables.
n
%
(95%CI)
Mo he s’
ma i al
s a us
Ma ied
o
a ached 692
83.2%
(80.6-
85.7)
Li ing
alone
140
16.8%
(14.3-
19.4)
Mo he ’s/ a he ’s/gua dian’s
age
25-30
1
0.1%
(0.00-
0.40)
31-40
146
17.6%
(15.0-
20.2)
41-50
607
73.0%
(70.0-
76.1)
51-60
72
8.7% (6.80-
10.6)
+60
5
0.6%
(0.10-
1.10)
Mo he ’s
le el
o
educa ion
P ima y
273
32.8%
(29.6-
36.0)
Seconda y
141
16.9%
(14.4-
19.5)
V/T
o
CC
169
20.3%
(17.6-
23.0)
Unde g adua e
107
12.8%
(10.6-
15.1)
Uni e si y
143
17.2%
(14.6-
19.7)
Coun y
o
o igin
Spain
689
83.1% (80.6-
85.7)
O he
140
16.9%
(14.3-
19.4)
Mo he s’
eligious
p ac ice
Regula
p ac ice
169
20.3%
(17.6-
23.0)
Occasional
p ac ice
218
26.2%
(23.2-
29.2)
Belie e
250
30.0%
(26.9-
33.1)
A heis
162
19.4% (16.8-
22.1)
No
answe
82
9.8%
(7.80-
11.9)
Gi ls
and
siblings
Wi h
siblings
713
85.5%
(83.2-
88.0)
Wi hou
siblings
120
14.9%
(12.0-
16.8)
Gi ls
li ing
wi h
Bo h
pa en s
658
79.0%
(76.2-
81.8)
Sepa a ed
mo he
o
widow 155
18.6%
(16.0-
21.3)
Sepa a ed
a he
o
widowe
8
1.0%
(0.30-
1.60)
G andpa en s
4
0.4%
(0.00-
0.90)
O he s
8
1.0%
(0.30-
1.60)
Mo he ’s
occupa ion
G adua es
o
manage s
204
28.7%
(24.2-
30.6)
Admin/sel -employed
100
22.6%
(11.0-
15.9)
ML
qualified
97
23,5%
(10.6-
15.4)
ML
semi-qualified
33
5.0%
(3.00-
5.90)
ML
non-qualified
311
13,2%
(38.2-
45.3)
Gi ls’
place
o
bi h
Spain
717
86.1%
(83.7-
84.8)
O he
116
13.9%
(11.6-
16.3)
Gi ls’
eligious
p ac ice
Regula
p ac ice
117
14.0%
(11.7-
16.4)
Occasional
p ac ice
133
16.0%
(13.5-
18.5)
Belie e
303
36.4%
(33.1-
39.6)
A heis
215
25.8%
(22.8-
28.8)
No
answe
65
7.8%
(6.00-
9.60)
CC:
communi y
college;
95%CI:
95%
confidence
in e al;
ML:
manual
labo ;
V/T:
oc/ ech
ins .
g oup
han
ha
included
in
he
analysis.
Howe e ,
when
compa -
ing
he
esul ing
sample
wi h
he
socio-demog aphic,
cul u al
and
amily
p ofile
o
he
gene al
popula ion6we
can
obse e
simila
p ofiles.
The
sampling
bias
is
hus
compensa ed
and
i
is
conside ed
ep esen a i e.
The
main
d i e s
associa ed
wi h
accina ion
we e:
•Coun y
o
o igin
o
he
mo he s:
he
mo he s’
coun y
o
o igin
as
a
de e mining
ac o
o
accina ion,
has
been
associa ed,
in
he
li e a u e,
wi h
he
di e ence
be ween
na i e
g oups
e -
sus
immig an
g oups,
possibly
due
o
cul u al
belie s.16 The
same
occu s
wi h
ce ical
sc eening,
since
immig an
women
do
no
unde go
as
many
smea
es s
as
na i e
women.17 One
may
also
associa e
hese
di e ences
wi h
he
socioeconomic
s a us
o
immig an
amilies
and
no
jus
wi h
hei
cul u al
belie s.18
P.
Na a o-Illana
e
al.
/
Gac
Sani .
2018;32(5):454–458
457
Table
2
Bina y
logis ic
eg ession
model
esul s
(n
=
833).
Va iables
Answe s
p
aOR
(95%CI)
Mo he ’s
coun y
o
o igin
Fo eign
( s.
Spanish) 0.042
0.49
(0,24-0,98)
Mo he ’s
ma i al
s a us
Ma ied
0.058
1
Sepa a ed
0.016
0.33
(0.13-0.81)
Widow
0.119
15.38
(0.49-480.2)
Di o ced
0.692
1.23
(0.44-3.40)
Single
0.143
0.27
(0.05-1.56)
A ached
0.478
0.58
(0.13-2.58)
Knowledge
abou
how
o
a oid
HPV
in ec ion
I
do
no
know
0.100
1
Yes,
i
can
be
a oided
0.474
0.76
(0.36-1.62)
No,
i
canno
be
a oided
0.114
1.56
(0.90-2.72)
The
sou ce
o
in o ma ion
abou
HPV
and
accine
was
he
physician
No
0.048
1
Yes
0.048
1.72
(1.01-2.94)
The
sou ce
o
in o ma ion
abou
HPV
and
accine
was
he
nu se
No
0.048
1
Yes
0.048
1.83
(1.01-3.35)
The
sou ce
o
in o ma ion
abou
HPV
and
accine
was
hei
iends
No
0.003
1
Yes
0.003
0.43
(0.24-0.77)
Has
ead
abou
he
accine
om
in o ma ion
leafle s
Yes
s.
no
0.002
2.32
(1.37-3.92)
Gi ls’
pe cep ion
abou
he
accine
Ve y
good
accine
o
p e en
ce ical
cance
<0.001
1
Ve y
good
accine
o
cance ,
bu
has
side
e ec s
<0.001
0.14
(0.08-0.25)
Good
accine,
bu
I
am
a aid
because
i
hu s
<0.001
0.15
(0.06-0.35)
Good
accine
o
a
disease
I
will
no
su e
om <0.001
0.01
(0.00-0.05)
In
he
las
yea
has
a ended
he
nu se’s
clinic
in
he
communi y
heal hca e
cen e
Ne e
0.017
1
Once
0.352
0.75
(0.42-1.37)
Mo e
han
once
0.025
2.12
(1.10-4.07)
Rega ding
ad ice
gi en
by
hei
nu se
(o
hei
physician)
I
ha e
no
spoken
o
hem
<0.001
1
I
ha e
been
ad ised
o
ha e
he
accine <0.001
6.57
(3.19-13.56)
I
ha e
been
old
o
decide
o
mysel
0.433
0.75
(0.36-1.56)
I
ha e
been
ad ised
no
o
ha e/delay
he
accine
<0.001
0.05
(0.01-0.22)
aOR:
adjus ed
odds
a io;
95%CI:
95%
confidence
in e al.
Howe e ,
his
is
no
he
case
he e
as
he e
is
ee
access
o
he
HPV
accine
in
Valencia.
The e o e,
we
conside
he
di e ence
o
be
due
o
he
exis ence
o
a
cul u al
ba ie .
•Ma i al
s a us
o
he
pa en s:
he
gi ls
whose
pa en s
we e
sepa-
a ed
we e
accina ed
less
o en
han
hose
li ing
in
a
adi ional
amily.
This
highligh s
he
heal h
p o ec ion
a
adi ional
amily
g an s
e sus
less
con en ional
amily
models.19
•Knowledge
abou
how
o
a oid
HPV
in ec ion:
knowledge
and
belie s
abou
HPV
accine
can
influence
he
accina ion
decision
di ec ly.
Howe e ,
a
eason
hey
a e
a
de e mining
ac o
is
due
o
he
pe cep ion
o
sa e y
and
e ficacy
ha
hese
knowledge
o
belie s
gi e
he
indi idual
when
making
a
decision.20
•In o ma ion
sou ce
abou
HPV
in ec ion
and
accine:
he
sou ce
o
in o ma ion
abou
he
accine
is
also
impo an .
In o ma ion
leafle s
issued
by
local
au ho i ies
we e
a
posi i e
ac o
o
ac-
cina ion,
al hough
he e
a e
s udies
ha
show
ha
ele ision
ad e ising
was
posi i ely
linked
o
accina ion
in
young
gi ls,
as
well
as
in e ne
in o ma ion,
which
also
had
a
s ong
influence
in
adolescen
gi ls
o e
eigh een
yea s
old.21
•Knowledge
abou
he
accine
om
in o ma ion
leafle s:
i
was
gene ally
s a ed
ha
mos
gi ls
and
mo he s
who
had
some
in o -
ma ion
abou
HPV
accine
had
seen
i
in
leafle s
issued
by
he
local
heal h
au ho i ies.14,19,20 I
seems
easonable
o
a fi m
ha
he
in o ma ion
campaign
ca ied
ou
among
he
a ge
popula-
ion
was
e ec i e.
•Gi ls’
pe cep ion
o
he
accine:
he
gi ls’
heal h
habi s
we e
he
same
as
hose
o
he
gene al
popula ion,
as
seen
in
he
Heal h
Su ey
o
he
Valencian
egion
o
ha
yea
(2011).22 I
needs
o
be
emphasized
ha
gi ls
who
we e
less
p one
o
d inking
alcohol,
o
ne e
ied
i ,
had
a
lowe
accina ion
a e
han
he
es .
Pe haps,
gi ls
wi h
a
cau ious
a i ude
owa ds
alcohol
had
a
lowe
isk
pe cep ion
abou
HPV
in ec ion.
We
can
conside
ha
a
mo e
conse a i e
p ofile
was
linked
o
less
isky
ac ions,
and
mo he s
and
daugh e s
had
an
o e all
lowe
isk
pe cep ion.
•Use
o
heal hca e
sys em
esou ces:
p e en i e
isi
o
hei
com-
muni y
nu se:
as
seen
in
di e en
s udies,23,24,26 gi ls
who
isi ed
hei
communi y
nu se
se e al
imes
in
he
las
yea
had
a
highe
accina ion
a e
han
hose
who
did
no
go
o
hei
heal hca e
cen e.
•Ad ice
om
a
nu se
o
physician:
his
linea
co ela ion
seems
based
on
he
impo ance
o
he
heal h
p o essional’s
ad ice,
whe e
he
nu se
plays
an
essen ial
ole
in
he
heal h
sys em.24,25
Nu ses,
as
well
as
doc o s,
lead
he
heal h
p ocesses
o
heal h-
ca e
use s,
and
hei
ad ice
defini ely
influences
accina ion.23,26
Howe e ,
his
influence
is
no
always
posi i e.
Wi hou
a
doub ,
he
main
de e mining
d i e
o
he
analysis
was
he
heal hca e
p o essional’s
ad ice,
mainly
nu sing
s a ,
as
hey
a e
he
ones
458
P.
Na a o-Illana
e
al.
/
Gac
Sani .
2018;32(5):454–458
di ec ly
in ol ed
in
he
accina ion
p ocess.
The
nu ses
who
endo sed
he
accine
ob ained
significan
esul s.
The
esul s
we e
equally
significan
when
hey
ad ised
agains
accina ion.
Many
s udies
ha e
shown
he
s ong
influence
ha
his
ec-
ommenda ion
can
ha e
on
pa en s
and
pa ien s
when
deciding
whe he
o
no
o
ha e
a
accine.8,12,13,26 The e o e,
adequa e
aining
and
in o ma ion
o
heal hca e
p o essionals
di ec ly
in ol ed
in
accina ion
endo semen ,
pa icula ly
nu ses,
could
imp o e
HPV
accine
accep ance.
Fo
his
eason,
all
he
ac ions
aimed
a
aining
heal hca e
p o essionals
in
de ec ing
he
cases
which
a e
less
likely
o
be
accina ed
and
aimed
a
eminding
pa ien s
abou
he
link
be ween
HPV
ch onic
in ec ion
and
ce -
ical
cance ,
as
well
as
accine
sa e y
and
e ficacy,
would
help
o
dec ease
HPV
in ec ion
and
inc ease
accine
co e age.27,28
O
all
he
ac o s
associa ed
wi h
accina ion,
ad ice
om
he
nu se
oge he
wi h
hei
physician’s
ad ice
was
he
main
de e mining
d i e .
The e o e,
i
is
essen ial
ha
heal hca e
p o-
essionals
a e
adequa ely
ained
o
in o m
pa ien s
abou
HPV
in ec ion
and
accina ion.
In e en ions
aimed
a
inc easing
ac-
cine
co e age
should
be
ocused
on
aising
nu ses’
and
doc o s’
HPV
awa eness
in
o de
o
imp o e
he
heal h
o
adolescen
gi ls.
Edi o
in
cha ge
En ique
Cas o
Sánchez.
T anspa ency
decla a ion
The
co esponding
au ho
on
behal
o
he
o he
au ho s
gua -
an ee
he
accu acy,
anspa ency
and
hones y
o
he
da a
and
in o ma ion
con ained
in
he
s udy,
ha
no
ele an
in o ma ion
has
been
omi ed
and
ha
all
disc epancies
be ween
au ho s
ha e
been
adequa ely
esol ed
and
desc ibed.
Wha
is
known
abou
he
opic?
HPV
accine
co e age
is
an
impo an
public
heal h
con-
ce n
and
unde s anding
he
easons
o
accep ing
o
ejec ing
accina ion
is
essen ial
o
inc easing
compliance.
Wha
does
his
s udy
add
o
he
li e a u e?
The
ad ice
om
he
nu se
and
physician
is
he
main
de e -
mining
d i e
associa ed
wi h
VPH
accina ion.
To
imp o e
he
HPV
accine
co e age
in
adolescen
gi ls
i
is
essen ial
ha
heal hca e
s a
a e
adequa ely
ained
when
i
comes
o
HPV
in ec ion
and
accina ion.
Au ho ship
con ibu ions
All
au ho s
we e
in ol ed
in
w i ing
he
manusc ip
and
app o e
o
i s
final
e sion.
Funding
None.
Conflic s
o
in e es
None.
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